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To surrender in dependence of another: The relationship with the ambulance clinicians as experienced by patients.
Karolinska Institutet, Sweden;Uppsala university, Sweden.ORCID iD: 0000-0003-1878-0992
Örebro University, Sweden.
Karolinska Institutet, Sweden.
Karolinska Institutet, Sweden;Ersta Sköndal university college, Sweden.
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 544-551Article in journal (Refereed) Published
Abstract [en]

Historically, the ambulance care has focused on acute transports and medical treatment, although ambulance care has also been reported as complex, encompassing more than just medical treatment and transports. Previous studies, on ambulance clinicians, have pointed out the importance of interpersonal caring activities complementary to the medical treatment. Those activities can be understood as taking part in the relationship between patients and ambulance clinicians, earlier described as essential and a core component of care. The aim of this study was to elucidate the meaning of the relationship with the ambulance clinicians as experienced by patients. Twenty ambulance patients were interviewed in the study. The interviews were transcribed verbatim and analysed with a phenomenological hermeneutical method to grasp meanings in the patients' experiences. The regional ethical committee approved the study. In the result emerged one main theme: To surrender in dependence of another. The main theme includes four themes: Being in the hands of another, Being in a caring temporary presence, Being important while involved and Being powerless while insignificant, and the themes comprise eleven subthemes. The main theme meant to have no other option than to surrender and to put their life into the hand of another. This surrender also meant to adapt to the clinicians' views even if not shared. This is experienced as excessive care. Summarised, the patients' experiences were both positive and negative and the findings provide a complex understanding of the relationship between the patient and the ambulance clinicians. Overall, the relationship embraces the whole person without reducing the patient to be a recipient of an objectified ambulance care.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014. Vol. 28, no 3, p. 544-551
Keywords [en]
ambulance care, caring science, patients, phenomenological hermeneutic method, prehospital emergency care, professional patient relationship
National Category
Nursing
Research subject
Care Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-79559DOI: 10.1111/scs.12079PubMedID: 24067194OAI: oai:DiVA.org:lnu-79559DiVA, id: diva2:1279334
Available from: 2019-01-16 Created: 2019-01-16 Last updated: 2019-05-14Bibliographically approved
In thesis
1. Being secure in insecurity: Aspects of caring in the ambulance service
Open this publication in new window or tab >>Being secure in insecurity: Aspects of caring in the ambulance service
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Ambulance care focuses foremost on medical care and treatment. On the one hand the ambulance service encounters persons suffering acute and severe physical illness or injuries; conversely ambulance patients are described, as being vulnerable to more than just their illness or injury. Ambulance care is provided in an insecure environment and ambulance clinicians have to be prepared for the unexpected. The overall aim of this thesis was to gain understandings of relationships and knowledge in caring, within the ambulance service.Four studies have formed the foundation of this thesis. Three different methods were used; phenomenological hermeneutics (I-II) with individual interviews, qualitative content analysis (III) with focus group conversations and finally a Delphi method (IV). Study I aimed to elucidate the meaning of the relationship with ambulance clinicians as experienced by patients. This was to surrender in dependence of another, being secure in the hands of the ambulance clinician. The situation developed from being lonely before the arrival of the ambulance, to being cared for by the ambulance clinicians and finally being lonely again when transferred to the Emergency Department. Study II aimed to elucidate the meaning of the relationship with the ambulance clinician as experienced by significant others. This was to be lonely together and secure while sharing their lonely struggle for the affected person with the ambulance clinician. At the same time the ambulance clinician’s focus was on the affected person leaving the significant others deserted and lonely. Study III aimed to elucidate ambulance clinicians’ experiences of relationships with patients and significant others. This was encapsulated in the main category; ‘To be personal in a professional role’. Being both personal and professional were found to be intertwined aspects of the relationship. The ambulance clinicians focus on the patient and are involved in creating comfort, having a professional mission to handle their own and the patient’s safety as a priority of the care. Study IV aimed to identify and estimate desired knowledge among Swedish ambulance clinicians from the perspective of ambulance care managers. This embraced a wide spectrum, including both medical and caring knowledge. The highest ranked desirable knowledge areas were; ‘Knowledge to assess the patient’s situation from a holistic perspective’, ‘Medical knowledge to assess and care for different diseases’ and ‘Knowledge to able to care for critically ill patients’. In conclusion, the thesis unfolds a complex understanding of caring in the ambulance service, being secure in insecurity. The patients and significant others are secure in the ambulance clinicians’ presence, but insecure when lonely and powerless. Caring in the ambulance service focuses on the physical disorder, but is understood from the body’s inseparable connection to the lifeworld. Care is fixed in time and often short. The ambulance clinicians have to care for patients and significant others while simultaneously handling an insecure environment. This calls for ambulance clinicians to adopt a holistic approach to care for both patients and significant others, and to acknowledge the whole person.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015. p. 56
Keywords
caring science, professional relationships, qualitative methods, prehospital emergency care, ambulance
National Category
Nursing
Research subject
Care Sciences
Identifiers
urn:nbn:se:lnu:diva-79588 (URN)978-91-7676-071-0 (ISBN)
Public defence
2015-12-11, Hörsal H2 Grön, Alfred Nobels Allé 23, Huddinge, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2019-02-18 Created: 2019-01-17 Last updated: 2019-02-18Bibliographically approved

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